When Ria Fu first felt contractions on the evening of December 10, 2023, she prepared herself for a challenging experience. However, as her labour stretched beyond an exhaustive two days without adequate pain relief, the emotional and physical toll became overwhelming. "The contractions were painful, but it was the uncertainty that was even harder to bear. After two days, I felt hopeless," she shared.

Prolonged labour affects approximately 8% of women, according to Dr. Serene Thain, a consultant at KK Women’s and Children’s Hospital. While some may view labour as a test of endurance, delays can have dire consequences for both mother and child.

What Is Prolonged Labour?

Prolonged labour is defined as any stage of childbirth that exceeds the expected duration. During the active first stage, when a woman dilates from more than 3cm to 10cm, the labour should progress at a rate of at least 1cm per hour. Typically, the second stage, which is the delivery phase, should last no longer than three hours.

Before this active stage, expectant mothers also go through a latent phase, where they may experience mild contractions and cramps. This phase can last from hours to even days, leaving women in a state of anticipation.

Causes of Prolonged Labour

Several factors contribute to the stalling of labour, as explained by Dr. Harvard Lin, an obstetrician at the Asian Obstetrics and Gynaecology Centre. Weak contractions, maternal pelvic shape, and the baby’s size or position can hinder progress. Women of advanced maternal age, high body mass index (BMI), or those with uncontrolled diabetes during pregnancy are also at increased risk.

Moreover, complications can arise, such as postnatal haemorrhage caused by uterine atony, where the womb fails to contract post-delivery, leading to severe bleeding. Rare but serious issues like uterine rupture can occur in extremely prolonged deliveries, while foetal distress from reduced oxygen supply during contractions is also a grave concern.

The Emotional Fall-Out

The impact of prolonged labour does not just end at physical exhaustion. Dr. Lin notes that the longer the labour, the more mental strain it inflicts on mothers. This can result in feelings of disappointment, trauma, or anxiety that could affect future pregnancies.

For example, Sarah, a mother who experienced nine torturous hours stuck at 5cm dilation, vividly recalls how demoralizing it was to sign the consent form for a caesarean section, departing from her original plan. However, her healthcare team provided much-needed reassurance during the process.

Managing Prolonged Labour

Experts recommend a variety of interventions to manage prolonged labour. In the initial stage, artificial rupture of membranes and administering oxytocin to strengthen contractions may be employed. If the second stage is prolonged, assisted delivery with vacuum extraction or forceps might become necessary. However, if fetal distress arises or if there’s no progress, a caesarean section may be deemed safer.

In cases where a mother insists on continuing vaginal delivery despite prolonged labour, doctors emphasize close monitoring and comprehensive discussions regarding risks, ensuring the mother feels empowered in her decision-making.

Prevention and Preparation

Proactive measures should begin early in pregnancy. Dr. Lin suggests that expectant mothers discuss their individual risk factors with healthcare providers. For those unable to modify certain risks—like age—incorporating the possibility of prolonged labour into their birth plans can be beneficial.

Understanding the labour process can bolster emotional resilience, as highlighted by Assoc Prof Su. Each labour can be unique, and maintaining an open mind about expectations can lead to a more positive experience.

In their journeys, both Ria and Sarah found solace in trusting their medical teams. After a prolonged struggle, Sarah’s labour advanced, allowing her to deliver vaginally. "There was a rush of relief and joy. Even with medical support, prolonged labour tested everything I had," she reflected.

Ria, on the other hand, learned that a positive mindset played a crucial role in her endurance. "I kept reminding myself that I was not alone in this. It was a challenging experience, but knowing it would eventually end gave me strength," she revealed.

Conclusion: The Resilience of Mothers

Prolonged labour is a complex challenge that tests both physical limits and emotional resilience. Through education, proper healthcare communication, and emotional support, mothers can navigate this arduous journey, ensuring that they emerge stronger for themselves and their newborns. If there’s one takeaway, it’s that no mother should feel alone in her struggle, and a supportive environment can make all the difference.